NPIMap

Organization Active NPI

Shadle Smile Source PLLC

  • Dental Clinic/Center
  • Spokane, WA
National Provider Identifier
1154083822
Registry record updated Oct 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
SHADLE SMILE SOURCE PLLC
Practice address
4610 N Ash St Ste 2O1
Spokane, WA 99205-1482
Phone
(509) 325-4313
NPI assigned
Oct 11, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Timothy Casey, DDSNPI 1942383534
Title
President
Phone
(509) 280-0002

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

4610 N Ash St Ste 2O1
Spokane, WA 99205-1482

Mailing address

2513 N Chase LN
Liberty Lake, WA 99019-7533

National Provider Directory

National Provider Directory

Locations

4610 N Ash St
Ste 2O1
Spokane, WA 99205
Phone (509) 325-4313

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633910400000",
    "number": "1154083822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2513 N CHASE LN",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990197533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4610 N ASH ST STE 2O1",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992051482",
            "telephone_number": "509-325-4313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADLE SMILE SOURCE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-11",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A",
        "authorized_official_last_name": "CASEY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-280-0002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.